Treating Varicose Veins

Varicose vein treatments can help you get a leg up on health.

ILLUSTRATION BY Benjamin Hjelm

Spring’s arrival signals that it’s time to relegate winter clothing to the back of the closet as we switch out bulky hats, coats and sweaters for T-shirts, shorts and maybe even (gasp!) bathing suits. But many people who have varicose veins feel unable to fully embrace the seasonal clothing swap, or even dread it, because they prefer to keep their legs covered up and unsightly leg veins under wraps.

Varicose veins usually occur when defective valves within veins enable blood to pool in the legs. Each valve should act as a sort of one-way gate that allows blood to pass through on its return trip up to the heart. When valves fail to close properly, blood travels back down the legs and stagnates there, creating pressure within the veins, and over time possibly causing veins to become enlarged and ropy-looking.

It might be easy to dismiss varicose veins as a purely cosmetic concern, but they can lead to troublesome health consequences over the long term. Varicose veins form in the superficial venous system, not in the deep veins that can harbor life-threatening blood clots. The majority of varicose vein patients, however, report symptoms beyond unattractive veins, such as legs that feel swollen, tired, achy, itchy, or heavy, especially following prolonged standing or at the end of the day, says James H. Rothstein, MD, FACS, a board-certified vascular surgeon at Seacoast Vein Center, Portsmouth Regional Hospital, and other area hospitals. Left untreated, varicose veins can lead to venous hypertension, venous ulcerations that necessitate wound care, and brownish discoloration around the bottom of the legs, as iron within the pooled blood leaches out and stains tissue.

Indeed, “varicose veins can be a serious health issue … [and] extremely disabling,” says Patricia C. Furey, MD, FACS, a board-certified vascular surgeon at The Surgical Care Group at Catholic Medical Center in Manchester. Varicose veins can pose problems particularly for elderly patients because vein-related ulcerations require chronic care. “We have patients in our practice who have had wounds for several years that have not healed because they have underlying vein disease that was never treated,” Furey says.

As those patients can attest, varicose veins will not get better on their own. “Once those veins are shot, they’re shot,” Rothstein says. Current varicose vein treatments can clear up unsightly veins and relieve related symptoms, however.

And unlike the tortuous-sounding vein stripping procedure commonly performed in the past, many of today’s varicose vein treatments are minimally invasive and likely to involve something called endovenous therapy. “‘Endo’ means we’re treating the veins from the inside,” Rothstein says. In some procedures, for example, doctors use a needle to insert a thin catheter and deliver a laser- or other energy-based trigger that closes down the primary vein that’s causing trouble. Typically only a local anesthetic is needed, patients feel no pain during the procedure — although they might experience some soreness later — and the treatment can be performed right in the doctor’s office.

Some patients also opt for a secondary procedure, such as vein injections or sclerotherapy, if they continue to be symptomatic or have lingering spider veins, which are small but visible veins. During sclerotherapy, the doctor injects a solution into the vein, “which causes an irritation of the vein wall and eventually causes obliteration of the vein,” Furey says.

The need to squeeze

If your family history includes varicose veins, there’s a good chance that you’ll get them, too. “There is a significant hereditary component to varicose veins,” Rothstein says. Pregnancy also increases a person’s likelihood of developing varicose veins, due to an increase in blood volume in the expectant mother. “Some women will get varicosities while they’re pregnant, and after they deliver, the blood volume goes back to normal and the varicosities will disappear. But if the veins get stretched beyond their limit and the valves become incompetent, after pregnancy, they’re going to stay [that way],” Rothstein says.

Men can develop varicose veins, too. “It’s an extremely prevalent condition in general,” Furey says. “Statistics show that up to 80 percent of people have some degree of varicose vein disease.”

Individuals whose jobs require them to stand for prolonged periods are particularly at risk. “A lot of my patients are standers,” Furey says. “They’re salon workers, teachers, nurses, healthcare workers, and people who work in a physical industry where they’re standing for long periods of time.”

To help lower your risk of developing varicose veins, wear lightweight compression when you know you’ll need to stand still for a long stretch of time. The gentle squeeze that compression stockings provide will help to prevent blood from pooling. Try to move, or at least flex your legs from time to time so that your calf muscles will contract and help propel the blood up and out of the leg. On a day-to-day basis, take advantage of the body’s natural compression system by staying active and keeping your weight down.

And if you think you have varicose veins, get them checked out by a doctor. Varicose vein sufferers “are among our happiest patients when we help them with their vein problem,” Furey says. “I’ve had patients who hadn’t been in a bathing suit for 30 years and didn’t show their legs [until they were treated]. There are men and women who had bleeding from their vein problems. It’s very gratifying to see them get better, and we have a lot of new treatments available to them that are much less invasive than they used to be 20 or 30 years ago.”